Protecting the weakest was the declared goal of politics when the coronavirus spread rapidly in Germany in the spring of last year.

That this did not succeed was not only shown sadly by the many corona outbreaks in old people's and nursing homes - it can also be proven with figures.

The mortality rate of residents of care facilities was already three weeks after the start of the first lockdown - i.e. at the beginning of April - 20 percent higher than the average of the five previous years, according to the care report published on Tuesday by the AOK Scientific Institute (Wido) Based on billing data from doctors and hospitals.

In the first three months of the second wave - from October to December - the level of previous years was even exceeded by 30 percent.

Britta Beeger

Editor in business.

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    "The infection control measures during the pandemic were not sufficient to adequately protect the people in need of care living in the home," said Antje Schwinger, head of the care research area at Wido and co-editor of the report.

    This can also be demonstrated by a few other key figures.

    Between April and June 2020, every third Covid-19 diagnosis (33 percent) in people over 60 was made by residents of nursing homes.

    A similar picture emerges for those Covid patients over 60 who were cared for in the hospital: Here, the proportion of those in need of full inpatient care is 30 percent.

    Isolation also has consequences

    The institute's analysis is based on accounting data from the nursing and health insurance funds of the AOK for the years 2015 to 2020, which comprise between 380,000 and 400,000 people in need of care aged 60 and over in fully inpatient nursing homes on an annual average. It can therefore be regarded as particularly valid. All insured persons for whom the Covid 19 diagnosis was confirmed by a PCR test were included. The Robert Koch Institute (RKI), on the other hand, is only notified of a small number of corona cases as to whether the affected persons lived in a care facility. The statistics of the federal states, which are usually responsible for home supervision, also show some gaps, according to their information.

    The report also shows what many experts expected early on in the pandemic: If they contract Covid-19, nursing home residents have a significantly higher risk of dying: of those in need of full inpatient care over 60 years of age who were treated in hospital, the evaluation died according to 45 percent - almost every second. Among those patients who were not cared for or were cared for on an outpatient basis, it was only 25 percent. The reason is probably that many people in need of care suffer from previous illnesses such as cardiovascular or immune diseases, dementia or cancer.

    All of these findings would have to be taken into account in future pandemic concepts - as well as the health and, in particular, psychological stresses for those in need of care due to visiting bans, curfews and contact bans within the facilities and the associated isolation, warns research department head Schwinger. The severe restrictions for home residents were discussed highly controversially in the first lockdown, also from an ethical point of view. The report states that care and participation were impaired “to an extent that is difficult to tolerate”.

    An online survey by Wido among 500 relatives of inpatient care recipients illustrates the extent of the restrictions: 43 percent of those surveyed reported that they had no personal contact between March and May 2020. Another third stated that this was seldom possible. The relatives also reported that 16 percent of those in need of care would not have been able to leave their own room, 25 percent rarely. So it is hardly surprising that the relatives also observed that the physical, mental and psychological condition of those in need of care was deteriorating. They often mentioned increased feelings of loneliness, dejection and listlessness, but also declining mental fitness and less physical agility. When interpreting, it should be noted thatthat it is external assessments in each case. According to the authors, the results tend to coincide with other surveys.

    In the second wave, politicians tried harder to maintain basic contacts and visits through FFP2 masks, rapid antigen tests for visitors and mandatory tests for staff. It is now urgent to check which of these protective measures should be part of the standard equipment for homes in future pandemics, write the authors of the report. And conclude: “What must never be used again to avoid risk is the general isolation of old women and men from the outside world and from their relatives.” A realization that politicians have also come to. For example, the Prime Minister of North Rhine-Westphalia and CDU Chairman Armin Laschet described the complete cordoning off of the homes as a mistake in an interview.